Arthroscopic Meniscal Repair Using the Outside-In Technique: Indications, Technique, and Results

The outside-in technique has been demonstrated to be effective for repair of most meniscal tears. Peroneal nerve injury is easily avoided during lateral meniscal repair using this technique because the starting point for needle entry is controlled. There are several advantages of this technique: sutures can be placed without the need for a rigid cannula, precise suture placement is possible because only small needles are used, visualization is facilitated because there are no instruments between the meniscus tear and the arthroscopic view, and the repair can be performed with small incisions with minimal dissection. This technique can be adapted for use of either permanent or absorbable suture, and is useful for suturing a meniscal replacement device (such as a meniscus allograft or collagen meniscus implant) or for securing materials such as a fibrin clot or a carrier containing growth factors to a repair site.